MEDICARE: DANICA SAN AGUSTIN ATIENZA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	14498426	NV

General Provider Information

NPI Number	:	1063346948
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANICA SAN AGUSTIN ATIENZA

Provider Business Mailing Address
First Line	:	9839 JAZZY JUNE ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89183-3535
Country	:	US
Telephone Number	:	702-379-3947
Fax Number	:

Provider Business Practice Location Address
First Line	:	9121 W RUSSELL RD STE 115
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-1238
Country	:	US
Telephone Number	:	702-499-6638
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2026
Last Update Date	:	06/09/2026

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Directions to “ DANICA SAN AGUSTIN ATIENZA ” Practice Location

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